Consistent with previous studies, elevated free intracellular calcium ion concentrations (Ca2+i) were found in blood platelets and lymphocytes of patients with mania and bipolar depression. ...Incubation with an ultrafiltrate of plasma from patients with bipolar illness had no effect on intracellular calcium ion concentration in platelets from normal subjects, suggesting that elevated Ca2+i is not due to a circulating factor. As was true in an earlier study of the effect of lithium on platelets, incubation with therapeutic levels of carbamazepine lowered Ca2+i in lymphocytes from affectively ill patients but not controls. Increased Ca2+i in peripheral cells may reflect a diffuse change in cellular homeostasis and may contribute to mixtures as well as rapid alternations of activity of affective, behavioral and physiologic systems in bipolar illness. Correction of the abnormality may at least be a marker of a relevant therapeutic action if it is not the action itself.
Dissociative symptoms have been the subject of psychiatric inquiry since the beginning of this century (Putnam 1992; Sanders 1986; van der Kolk and van der Hart 1989). Although recent investigations ...have focused on the four specific dissociative disorders (American Psychiatric Association 1994) and their relationship to early traumatic experiences (Chu and Dill 1990; Putnam 1985; Terr 1991), dissociative symptoms have been reported in virtually every major psychiatric disorder (Bremner et al. 1992; Goff et al. 1992; Steinberg 1992), and, in less severe forms, even in nonpatient populations (Briere 1988; Putnam 1992; Ross and Joshi 1992). These observations raise questions about the clinical significance of dissociative symptoms that occur when other mental disorders are also present (Coons 1984; Fahy 1988).
Serotonin is a ubiquitous neurotransmitter with widespread projections that provide for the involvement of serotonin in the regulation of many biological and psychological functions. A variety of ...serotonin receptor subtypes exist that mediate overlapping psychobiological functions and that are targets for a new generation of medications. Although these new generation medications appear to possess great biochemical specificity, their actions extend to many psychiatric disorders, reflecting the many interactions of serotonergic subsystems.
Although depression is common among patients receiving maintenance hemodialysis, data on their acceptance of treatment and on the comparative efficacy of various therapies are limited.
To determine ...the effect of an engagement interview on treatment acceptance (phase 1) and to compare the efficacy of cognitive behavioral therapy (CBT) versus sertraline (phase 2) for treating depression in patients receiving hemodialysis.
Multicenter, parallel-group, open-label, randomized controlled trial. (ClinicalTrials.gov: NCT02358343).
41 dialysis facilities in 3 U.S. metropolitan areas.
Patients who had been receiving hemodialysis for at least 3 months and had a Beck Depression Inventory-II score of 15 or greater; 184 patients participated in phase 1, and 120 subsequently participated in phase 2.
Engagement interview versus control visit (phase 1) and 12 weeks of CBT delivered in the dialysis facility versus sertraline treatment (phase 2).
The primary outcome for phase 1 was the proportion of participants who started depression treatment within 28 days. For phase 2, the primary outcome was depressive symptoms measured by the Quick Inventory of Depressive Symptoms-Clinician-Rated (QIDS-C) at 12 weeks.
The proportion of participants who initiated treatment after the engagement or control visit did not differ (66% vs. 64%, respectively; P = 0.77; estimated risk difference, 2.1 95% CI, -12.1 to 16.4). Compared with CBT, sertraline treatment resulted in lower QIDS-C depression scores at 12 weeks (effect estimate, -1.84 CI, -3.54 to -0.13; P = 0.035). Adverse events were more frequent in the sertraline than the CBT group.
No randomized comparison was made with no treatment, and persistence of treatment effect was not assessed.
An engagement interview with patients receiving maintenance hemodialysis had no effect on their acceptance of treatment for depression. After 12 weeks of treatment, depression scores were modestly better with sertraline treatment than with CBT.
Patient-Centered Outcomes Research Institute, Dialysis Clinic, Kidney Research Institute, and National Institute of Diabetes and Digestive and Kidney Diseases.
Baseline and thrombin-stimulated free intracellular calcium concentrations in blood platelets were significantly higher in untreated depressed bipolar patients than in untreated unipolar depressed ...patients or controls. Platelet intracellular calcium ion concentrations in euthymic-treated bipolar patients were equivalent to control values, suggesting but not proving a state-dependent change in intracellular calcium ion dynamics in bipolar depression. Unipolar and some subsets of bipolar patients appear not to exhibit this change.
Psychotic depression is a unique subtype of depressive illness in which mood disturbance is accompanied by delusions, hallucinations, or both. Once considered relatively uncommon, it is frequently ...encountered in clinical practice, particularly in treatment-resistant depressed patients. Psychotically depressed patients respond poorly to antidepressants, but remission is likely with neuroleptic-antidepressant combinations or electroconvulsive therapy. Psychotic depression may be unipolar or bipolar with early or late onset and may be more likely to occur in patients with a history of childhood psychic trauma. Much is known about the course and treatment response of obvious presentations of psychotic depression, but more must be learned about depressed patients who have intermittent, subtle, or mild psychotic symptoms and about the ways in which the capacity to become psychotic interacts with the capacity to become depressed to produce a syndrome greater than the sum of its parts.
Pancreatitis is usually considered a rare side effect of valproate. We describe five cases of pancreatitis and one case of cholecystitis associated with the use of valproate.
Through chart review, we ...identified all patients in our facility treated with valproate between 1989 and 1994, and all cases of pancreatitis and cholecystitis identified during that same period in our population of 322 mentally retarded patients. We also searched MEDLINE for all published cases of pancreatitis or cholecystitis associated with valproate treatment.
Five (7%) of 72 valproate-treated patients experienced pancreatitis, and one experienced cholecystitis; all recovered fully. This brings the total number of reported cases of valproate-associated pancreatitis to 55.
Pancreatitis may occur more frequently than previously recognized in mentally retarded adults treated with valproate. Developmentally disabled patients should be carefully monitored for this potentially lethal side effect.
